PB2127: NO IMPACT OF STATIN USE ON RESPONSE AND SURVIVAL RATES IN NEWLY DIAGNOSED DLBCL PATIENTS TREATED WITH R-DA-EPOCH
Authors: A. Sabljic, M. Sedinic, R. Kusec, V. Pejsa, M. Lucijanic
Journal: HemaSphere (2022)

Background: There are controversial clinical data on potential benefits of statin use concomitantly with immunochemotherapy in the first line treatment of agressive Non Hodgkin lymphoma (NHL) patients. Majority of information is based on R-CHOP treated cohorts. Recent reports indicate that statins might improve chemosensitivity of tumor cells to doxorubicine and diffuse large B cell lymphoma (DLBCL) patients concomitantly treated with statins in addition to R-CHOP might experience improved response rates and improved survival. Aims: We aimed to evaluate whether concomitant statin use resulted in improved outcomes in our cohort of newly diagnosed DLBCL patients with unfavorable disease features treated with R-DA-EPOCH regimen. Methods: We retrospectively evaluated all consecutive first line DLBLC patients who presented to our institution in period 2005-2019 and who were treated with R-DA-EPOCH regimen. All patients were Caucasians and had unfavorable disease features (Ki67+ ≥80% and/or International Prognostic Index (IPI) ≥2 points). Electronic and written medical records were analyzed for statin use at the time of immunochemotherapy. Clinical and laboratory features, as well as outcome measures (response rates, progression free and overall survival) were compared between patients with and without concomitant statin use. Results: A total of 130 newly diagnosed DLBLC patients were evaluated. Median age was 62 years IQR (48-71), there was a similar proportion of male (73/130 (56.2%)) and female patients (57/130 (43.8%)). Median R-IPI score was 3 points IQR (2-3). A total of 17/130 (13.1%) patients received statins concomitantly with immunochemotherapy (atorvastatin (11/17, 65%), rosuvastatin (4/17, 24%), simvastatin (2/17, 12%)). There were no significant differences in baseline demographic and clinical characteristics between patients concomitantly exposed and non-exposed to statins. Also, there were no significant differences in number of cycles with R-DA-EPOCH dose escalation, reduction, anemia, thrombocytopenia, neutropenia, febrile neutropenia and septic complications. Also, there was no significant difference in proportion of patients achieving complete (53% vs 66%) or partial response (24% vs 19%) between patients exposed and non-exposed to statins. Median follow-up of our cohort was 48 months. Statin use had no significant association with neither OS (P=0.480) nor PFS (P=0.891) as shown in Figure. To account for potential age, sex and disease biology differences between patients with and without statin exposure we evaluated statin use in a logistic regression model assessing predictors of response to therapy where only lower R-IPI score was significantly associated with achieving the response (OR 0.44 95% CI (0.21-0.94), P=0.035), whereas statin use (P=0.909), age (P=0.119) and sex (P=0.291) had no significant associations. In a similar Cox regression model assessing predictors of PFS, achieving response to therapy was statistically significant (HR 0.08 95% CI (0.03-0.21), P<0.001) and there was a tendency for higher R-IPI (HR 1.36 95% CI (0.99-1.87), P=0.058) to be associated with PFS, whereas there were no significant associations of statin use (P=0.674), age (P=0.597) and sex (P=0.151) with PFS. Image:Summary/Conclusion: Our data on first line DLBLC patients with unfavorable disease features treated with R-DA-EPOCH regimen do not confirm previously reported observations of improved response rates nor improved PFS with concomitant statin use. Differences in immunochemotherapy regimens and underlying disease biology might play a role in observed differences.